TY - JOUR

T1 - Provision of social-norms feedback to general practices whose antibiotic prescribing is increasing

T2 - a national randomized controlled trial

AU - Gold, N.

AU - Ratajczak, M.

AU - Sallis, A.

AU - Saei, A.

AU - Watson, R.

AU - van Schaik, P.

AU - Bowen, S.

AU - Chadborn, T.

PY - 2022/10/31

Y1 - 2022/10/31

N2 - Aim: The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing. Subject and methods: We conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘The great majority (80%) of practices in England reduced or stabilised their antibiotic prescribing rates in 2016/17. However, your practice is in the minority that have increased their prescribing by more than 4%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018. Results: We randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β <−0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β <−0.01, z = −36.36, p <0.001). Conclusions: A social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter. Trial registration: NCT03582072.  

AB - Aim: The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing. Subject and methods: We conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘The great majority (80%) of practices in England reduced or stabilised their antibiotic prescribing rates in 2016/17. However, your practice is in the minority that have increased their prescribing by more than 4%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018. Results: We randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β <−0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β <−0.01, z = −36.36, p <0.001). Conclusions: A social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter. Trial registration: NCT03582072.  

KW - Antibiotics

KW - Antimicrobial resistance

KW - Feedback

KW - Primary care

KW - Social norms

U2 - 10.1007/s10389-021-01645-4

DO - 10.1007/s10389-021-01645-4

M3 - Journal article

VL - 30

SP - 2351

EP - 2358

JO - Journal of Public Health

JF - Journal of Public Health

SN - 1613-2238

IS - 10

ER -